Research Advisory Committee on Gulf War Veterans' Illnesses

228 Pages·2008·7.53 MB·English

by  Callie Comtois

RAC-GWVI Meeting Minutes
April 7-8, 2008
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Research Advisory Committee on Gulf War Veterans’ Illnesses

April 7-8, 2008, Committee Meeting Minutes

Boston University School of Public Health
Boston, MA
RAC-GWVI Meeting Minutes
April 7-8, 2008
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DEPARTMENT of VETERANS AFFAIRS

Research Advisory Committee on Gulf War Veterans’ Illnesses
Boston University School of Public Health
715 Albany Street, T4W, Boston, MA 02118
Phone: [phone], Fax: [phone]

I hereby certify the following minutes as being an accurate record of what transpired at the
April 7-8, 2008 meeting of the Research Advisory Committee on Gulf War Veterans’
Illnesses.

______________________________________
/signed/
James H. Binns
Chairman
Research Advisory Committee on Gulf War Veterans’ Illnesses
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Table of Contents

Attendance Record……………………………………………………………………5

Abbreviations………………………………………………………………………….6

Meeting Agenda……………………………………………………………………….7

Day 1…………………………………………………………………………………...9

Welcome, introductions, and opening remarks……………………………………..9

Introduction of Boston University RAC scientific staff……………………………10

Tissue factor and Gulf War associated chronic coagulopathies…………………..10

Bowel disorders in Gulf War veterans……………………………………………...13

Perspectives on gastrointestinal illness in Gulf War veterans…………………….16

Results of Rhode Island Persian Gulf War state survey of Gulf War veterans….20

ITI Gulf War research report……………………………………………………….21

Update of recent Gulf War research………………………………………………..23

Update of VA Gulf War research…………………………………………………...26

Update of VA Gulf War brain bank………..............................................................28

Public Comment - Day 1.............................................................................................32

Day 2.............................................................................................................................34

2008 Research Advisory Committee report discussion……………………………34

UT Southwestern Medical Center research program discussion…………………36
General Recommendations……………………………………………………36
Case Definitions Recommendations…………………………………………..41
Sampling Study Recommendations…………………………………………...44
Serum DNA Bank Recommendations………………………………………...46
Neuroimaging and Neuropsychological Projects Recommendations...……….48
Other Clinical Evaluation Recommendations………………………………....49
Preclinical Studies Recommendations...............................................................50

Public Comment - Day 2..……………………………………………………………56
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Appendix A...................................................................................................................58
Presentation 1 – Roberta White.........................................................................58
Presentation 2 – Ronald Bach............................................................................65
Presentation 3 – Ashok Tuteja...........................................................................77
Presentation 4 – Avlin Imaeda and Fred Gorelick...........................................100
Presentation 5 – Richard Valente.....................................................................116
Presentation 6 – Allen Fienberg.......................................................................139
Presentation 7 – Beatrice Golomb....................................................................164
Presentation 8 – Dan Clauw.............................................................................181
Presentation 9 – Louis Fiore and Neil Kowall.................................................188
Presentation 10 – UTSW Discussion...............................................................211
Appendix B.................................................................................................................225
Handout 1 – William Goldberg.......................................................................225
Public Comment 1 – Edward Bryan................................................................226
Public Comment 2 – Denise Nichols...............................................................228
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Attendance Record

Members of the Committee
James H. Binns, Chairman
Carrolee Barlow
Floyd E. Bloom
Daniel J. Clauw
Beatrice A. Golomb
Joel C. Graves
Anthony Hardie
Marguerite L. Knox
William J. Meggs
James P. O’Callaghan
Lea Steele
Adam Such
Roberta F. White

Committee Staff
Callie Comtois
Kimberly Sullivan

Designated Federal Officer
William Goldberg

Guest Speakers
Ronald Bach
Allen A. Fienberg
Louis Fiore
Fred S. Gorelick
Avlin Imaeda
Neil Kowall
Ashok Tuteja
Richard J. Valente

Representative from the University of Texas Southwestern
Robert Haley
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Abbreviations

AChE Acetylcholinesterase
ALS Amyotrophic Lateral Sclerosis
BU Boston University
BUSPH Boston University School of Public Health
CMI Chronic Multisymptom Illness
CDC Centers for Disease Control and Prevention
CDMRP Congressionally Directed Medical Research Programs
CFS Chronic Fatigue Syndrome
CRADO Chief Research & Development Officer for the VA
DOD Department of Defense
FY Fiscal Year
GI Gastrointestinal
GW Gulf War
IBD Inflammatory Bowel Disease
IBS Irritable Bowel Syndrome
IOM Institute of Medicine
IRB Institutional Review Board
ITI Intra-cellular Therapies, Inc.
LTC Lieutenant Colonel
MCS Multiple Chemical Sensitivity
MRI Magnetic Resonance Imaging
MS Multiple Sclerosis
NIH National Institutes of Health
OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
PB Pyridostigmine Bromide
PET Positron Emission Tomography
PI Principal Investigator
PTSD Post Traumatic Stress Disorder
RAC, RAC-GWVI Research Advisory Committee on Gulf War Veterans’ Illnesses
TF Tissue Factor
TF PCA Tissue Factor Procoagulant Activity
U.K. United Kingdom
UTSW University of Texas Southwestern School of Medicine
VA U.S. Department of Veterans Affairs
VISN Veterans Integrated Services Network
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Meeting of the Research Advisory Committee on Gulf War Veterans’ Illnesses
April 7-8, 2008
BUSPH, Crosstown Center, 801 Massachusetts Ave., Room 462, Boston, MA
Agenda
Monday, April 7, 2008

8:00 – 8:30 Informal gathering, coffee

8:30 – 8:35 Welcome, introductory remarks Mr. Jim Binns, Chairman
Res Adv Cmte Gulf War Illnesses

8:35 – 9:00 Introduction of Boston University RAC Dr. Roberta White, Scientific Director
scientific staff Res Adv Cmte Gulf War Illnesses

9:00 – 9:45 Tissue factor and Gulf War associated Dr. Ronald Bach
chronic coagulopathies Minneapolis VA Medical Center

9:45 – 10:00 Break

10:00 – 10:45 Bowel disorders in Gulf War veterans Dr. Ashok Tuteja
VA Medical Center, Salt Lake City

10:45 -11:15 Perspectives on gastrointestinal illness Dr. Fred Gorelick
in Gulf War veterans Dr. Avlin Imaeda
VA Conn. Healthcare System, West Haven
Yale University

11:15-11:45 Group discussion related to gastroenterological
problems in Gulf War veterans

11:45 – 12:30 Results of Rhode Island Persian Gulf War Brig. General Richard Valente (ret.)
state survey of Gulf War veterans Rhode Island Persian Gulf War
Information and Relief Commission

12:30 - 1:30 Lunch

1:30 - 2:15 ITI Gulf War research report Dr. Allen Fienberg
Intra-Cellular Therapies, Inc.

2:15 - 3:00 Update of recent Gulf War research Dr. Beatrice Golomb
Dr. Daniel Clauw
Res Adv Cmte Gulf War Illnesses

3:00 – 3:15 Break

3:15 - 3:45 Update of VA Gulf War research Dr. William Goldberg
VA Office of Research and Development

3:45 – 4:30 Update of VA Gulf War brain bank Dr. Louis Fiore
Dr. Neil Kowall
VA Boston Healthcare System

4:30 - 5:00 Public Comment
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Meeting of the Research Advisory Committee for Gulf War Veterans’ Illnesses
April 7-8, 2008
BUSPH, Crosstown Center, 801 Massachusetts Ave., Room 462, Boston, MA
Agenda
Tuesday, April 8, 2008

8:00 – 8:30 Informal gathering, coffee

8:30 – 9:30 2008 Research Advisory Committee report Dr. Lea Steele
discussion Res Adv Cmte Gulf War Illnesses

9:30 – 10:30 University of Texas Southwestern Medical Mr. Jim Binns, Chairman
Center research program discussion Res Adv Cmte Gulf War Illnesses

10:30 – 10:45 Break

10:45 – 1:30 University of Texas Southwestern Medical Mr. Jim Binns, Chairman
Center research program discussion Res Adv Cmte Gulf War Illnesses

1:30 – 2:00 Public Comment

2:00 Adjourn
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Day 1

The April 7-8, 2008 meeting of the Research Advisory Committee on Gulf War Veterans’
Illnesses was held in Room 462/462A of the Crosstown Center Building, at Boston University
School of Public Health, 801 Massachusetts Avenue, Boston, MA.

Welcome, introductions, and opening remarks
James H. Binns, Chairman

Chairman James Binns called the meeting of the Research Advisory Committee on Gulf War
Veterans’ Illnesses (hereinafter referred to as the “Committee”) to order at 8:30 am. He began
by thanking Dr. Roberta White and her staff at Boston University for hosting the meeting, and
setting up hotel accommodations in a location convenient to the meeting facilities. He welcomed
the members of the Committee, BU faculty, the audience, any veterans in attendance, and all of
the guest speakers.

Chairman Binns began by introducing two new members of the Committee. The first new
member was Dr. Dedra Buchwald, who was unable to attend the meeting because of the late
notice of the meeting’s dates. Dr. Buchwald is from the University of Washington, and is an
expert on CFS. She hopefully will be joining us at our next meeting.

The second new member is LTC Adam Such. He is currently the Executive Officer of 5th
Special Forces Group at Fort Campbell. He graduated in 1989 from West Point and as a young
Lieutenant served in the Gulf War as a Rifle Platoon Leader in northern Iraq. LTC Such has had
a distinguished career in Special Forces since then – from January 2003 until the middle of 2006,
he spent all but 8 months in OIF/OEF. He planned the infiltration of Special Forces into
Baghdad in advance of conventional forces as Senior Commander of Special Operations Forces,
in al-Anbar province. For most of the period, he served as the Operations Officer for the Joint
Special Operations Command in Baghdad, with responsibility for all but northern Iraq, including
over 1,000 of the Joint Special Operations Forces, the Iraqi Special Operations Forces, and a
division or more of Iraqi military forces. Lieutenant Such brings with him an extensive
background of knowledge about current military operations, and has also been recognized for his
analytical abilities. The tactics being used in Iraq today were developed by his group in al-Anbar
province, working with the local population and local leadership to pacify the area and engender
cooperation. He was the leader of the Special Operations component of the Army Chief of
Staff’s review of OIF. He will be a great asset to the Committee, and believes strongly in the
role the Committee plays in informing current military operations, as well as its importance to
veterans. Chairman Binns thanked LTC Such for joining the Committee, and the rest of the
Committee welcomed LTC Such with a round of applause.

Chairman Binns recognized the contributions of Dr. Lea Steele, who served as the Scientific
Director for the four and a half years prior. He asked Dr. Steele to join him at the podium, where
he informed the audience that although she was stepping down as the Scientific Director, Dr.
Steele would continue to be a member of the Committee, work on the 2008 report, review the
research program at UTSW, and serve on the CDMRP review board. He compared her role in
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the Committee to the 100th anniversary of the first successful journey to the North Pole: if the
Committee was a dogsled engaged in a scientific journey to the North Pole, Dr. Steele would
have been the compass, map, blanket, and dogs. Dr. Steele has kept the Committee on a course
that has made great progress, and kept true to scientific standards while doing so. Chairman
Binns presented Dr. Steele with a framed copy of the 2004 Committee report, and asked each
Committee Member to sign the cover so Dr. Steele could keep it as a memento of her time as
Scientific Director. Chairman Binns thanked Dr. Steele.

Chairman Binns welcomed Dr. Roberta White, who has been involved with Gulf War related
research since 1992, as the new Scientific Director of the Committee. Dr. White will be
committing 40% of her time to the Committee, while maintaining her current role as the
Chairman of the Department of Environmental Health at Boston University School of Public
Health. He invited Dr. White to introduce the new Committee staff, as well as to describe her
plans for a ‘team approach’ to studying Gulf War illness research and related topics.

Introduction of Boston University RAC scientific staff
Dr. Roberta White, Scientific Director
Chair, Department of Environmental Health, BUSPH

Dr. White noted that she was pleased to be taking on the role of Scientific Director, and stated
that she has a strong interest in Gulf War research. She thanked the Committee and audience for
coming to Boston, as she wanted everyone to meet the new staff and to see the RAC’s new
facilities. Dr. White introduced the Committee staff working through BUSPH (See Appendix –
Presentation 1), and introduced some of the members of the internal scientific review committee.
This group will be made up of Dr. White’s colleagues at BU, and will serve to review relevant
Gulf War research literature. Several members of this team have yet to be determined. Dr.
White expressed her excitement at having this review committee become an additional resource
for the RAC.

Chairman Binns thanked Dr. White. He stated that he has always had goal to have the RAC
meetings take a multi-disciplinary approach to integrating information from various scientific
fields; Dr. White’s ‘team approach’ idea is a step to achieving that goal. Chairman Binns
expressed his hope that this internal committee will aid in gaining answers to the questions the
Committee has been trying to answer for the last six years.

Chairman Binns introduced Dr. Ronald Bach.

Tissue factor and Gulf War associated chronic coagulopathies
Ronald Bach, PhD
Research Health Scientist, VA Medical Center, Minneapolis, MN
Associate Professor, Dept. of Medicine, University of Minnesota School of Medicine

Dr. Bach gave an overview of the research project he and his colleagues at the VA Medical
Center in Minneapolis, MN had recently completed. The study tested the hypothesis that tissue